Provider Demographics
NPI:1265646905
Name:JOHN & ELIZABETH NGUYEN DENTAL CORP
Entity Type:Organization
Organization Name:JOHN & ELIZABETH NGUYEN DENTAL CORP
Other - Org Name:YOSEMITE DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TIEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:925-961-1101
Mailing Address - Street 1:5733 NEWFIELDS LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-8781
Mailing Address - Country:US
Mailing Address - Phone:925-719-0532
Mailing Address - Fax:
Practice Address - Street 1:1352 CONCANNON BLVD
Practice Address - Street 2:BUILDING H
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6004
Practice Address - Country:US
Practice Address - Phone:925-961-1101
Practice Address - Fax:925-961-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93352-01Medicare ID - Type UnspecifiedDENTI-CAL